The Value of the Logbook
After 16 years guiding patients as a registered nurse, I was diagnosed with type 1 diabetes in 1996. For the first time, I learned how it felt to be the patient.
I remember clearly those early doctor's office visits when my own nurse educator, Judy Pentedemos, always came around to the same question: Did you bring your blood glucose numbers?
Judy was a strong believer in the value of logbooks. And my answers to her question rarely satisfied her. Usually, all I had to show after rummaging around in my jacket pocket or purse would be the meter itself, which I'd hand over with a "They're in there." Wrong response! To Judy, this was a mindless collection of data. I, of course, loved not having to record my numbers by hand. What a time-saver! Later, after Judy eventually hired me, our differing opinions on the subject became fodder for lunchtime debates.
I silently hatched a plot to prove my logbook-loving colleagues wrong. I decided to write out my previous month's blood glucose numbers on a sheet of paper. I would demonstrate that I had achieved good control that month, without ever having touched the all-powerful logbook.
Shortly after beginning my experiment, I started to notice a pattern among my post-dinner blood glucose readings. I knew I'd gotten high glucose near bedtime a few times, but certainly not this often! Then I noticed that my lunchtime numbers were consistently lower than my goal. With the data in front of me in black and white, I came to a sobering realization: Maybe my control hadn't been so great after all. I began to correct my bedtime highs and to ever so slightly increase my frequency of testing around lunchtime. But I said nothing to my coworkers about my logbook exercise.
While quietly recording my own numbers, I began gently encouraging my patients to do the same. Logbook comments matter, too. Things like "sick today," "out for walk," and "graduation party" can help explain results and also prompt beneficial changes in self-management. For example, if you notice that you always have high blood glucose after eating pizza, you may try adding a post-meal walk the next time you indulge.
The meter's memory is helpful if you forget to write down a number and need to retrieve it, but otherwise it really is, as Judy thought, just a mindless collection of data. Inexpensive and at the same time invaluable, your logbook can hold the key to successful diabetes self-management. Though I lost the argument with my coworkers, I still came out a winner: I learned firsthand the value of the logbook. That's a lesson I've applied every day to help achieve better diabetes management for my patients, and for myself.
Laurie Terrio, RN, BSN, CDE lives with her husband and two children in Nashua, N.H. She manages an ADA-recognized diabetes education program at St. Joseph Hospital Diabetes and Endocrinology Clinic in Nashua.